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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803639
Report Date: 12/19/2023
Date Signed: 12/22/2023 09:27:49 AM


Document Has Been Signed on 12/22/2023 09:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:PEOPLE'S CARE CHARMIANFACILITY NUMBER:
496803639
ADMINISTRATOR:SEAWRIGHT, PATRICKFACILITY TYPE:
740
ADDRESS:5087 CHARMIAN DRTELEPHONE:
(951) 775-7411
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:4CENSUS: 3DATE:
12/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Patrick Seawright, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a required Annual inspection and was greeted by Patrick Seawright, Administrator. Facility currently has three (3) residents in care. Facility contact information was reviewed. Patrick Seawright Administrator Certificate 6039802740 expires 5/25/2024.

At approximately 9:30am LPA and Administrator toured the building and grounds. The facility was found to be clean and at a comfortable temperature. LPA observed at least a 2 day supply of perishable and 7 day supply of non-perishable food. Food was found to be stored in a safe manner with open items covered and labeled. Kitchen drawer containing sharp knives was locked.



All bedrooms were equipped with lighting, night stand, and chest of drawers. All bedrooms were clean and in good repair. Extra hygiene products and linens were available. Resident bathrooms had required bath mats but did not have non-skid backing. Per Title 22 regulation 87303(e)(5), Non-skid mats or strips shall be used in all bathtubs and showers, see Technical Violation. Water temperature in sink(s) accessible to residents in care measured at 106.7 and 107.5 degrees F, respectively, which is within the allowable range of 105 to 120 degrees F.

Fire extinguishers were last inspected November 2023. Smoke/Carbon Monoxide detectors located throughout the facility were tested. Facility’s last quarterly disaster drill was conducted on December 14, 2023. Facility has a backup generator for use during a power outage. Fireplace in dining room not screened. Per Title 22 regulation 87307(d)(7) Fireplaces and open-faced heaters shall be adequately screened, see Technical Violation.


Report continued on LIC 809C...
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:
DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PEOPLE'S CARE CHARMIAN
FACILITY NUMBER: 496803639
VISIT DATE: 12/19/2023
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Continued from 809...

At approximately 11:00am LPA and Administrator conducted a review of 3 out of 3 resident records and 5 of 5 staff records. All required documents present.

At approximately 1:00pm LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored in a locked cabinet in the living room.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

LIC500- Personnel Report
LIC308- Designation of Responsibility
Evidence of Liability Insurance
Copy of current lease
Surety Bond

Exit interview conducted with Administrator and a copy of this report was given.

SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christi CoppoTELEPHONE: (707) 588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 12/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2023
LIC809 (FAS) - (06/04)
Page: 2 of 4